All posts by Usman Khawaja

Good health care is always a team effort—especially for people with chronic kidney disease. This fact sheet tells you about the health professionals who care for dialysis patients. For information about the health care professionals who care for transplant recipients, see “Your Transplant Care Team. ”

You and your family are important members of the dialysis care team. You should take an active role in your care. Learn all you can and take part in your treatment plan.

Since each member of the team at your dialysis center contributes to your care, it is important for you and your family to work together with them. The members of your dialysis care team are:

Nephrologist (Kidney Doctor)

The team leaders in many clinics are doctors called nephrologists—or, to use an easier term, kidney doctors. They have advanced training in treating kidney disease. They are responsible for your care during dialysis treatments. Nephrologists also may take care of patients before and after a kidney transplant.

Advanced Practitioner

Your team may also include advanced practitioners. Nurse practitioners (NP) and Physician Assistants (PA) collaborate with the doctors in caring for kidney patients both in medical offices or in the dialysis unit.

Nephrology Nurse

Nephrology nurses are licensed RN and LPN nurses who specialize in the care of patients with kidney failure. They are responsible for assessing patients, assuring that patients’ medications and treatment are administered correctly and for overseeing the dialysis process on a daily basis. All Medicare-certified facilities must have a full-time RN experienced in dialysis. The RN is responsible for nursing services and also oversees home programs that train patients and their care partners for self-dialysis modalities including home hemodialysis, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

Advanced practice nurses, nurse practitioners and clinical specialists with graduate nursing education degrees collaborate with the doctors in caring for kidney patients both in medical offices or in the dialysis unit.

Renal Dietitian

Renal dietitians have specialized degrees in dietetics and must meet certain education requirements to be registered dietitians (RDs). They know what foods are right for you, and they can help you plan your meals. Following a diet is an important part of your care, both before and after starting dialysis. Renal dietitians are skilled in tailoring your diet to meet your unique needs. They are also involved in the overview of bone management, dialysis adequacy, rehabilitation and anemia management.

Nephrology Social Worker

Nephrology social workers have a master’s degree in clinical social work and are licensed or certified. Your social worker can provide counseling to help you and your family cope with kidney disease and changes in the family, home, workplace and community. They can help you plan treatment to fit your lifestyle. They identify sources of emotional support for patients who need it. They also identify services provided by federal, state and community agencies to meet your needs and help you and your family obtain services when necessary. Social workers can help you and your family improve your quality of life.

Patient Care Technician and Biomedical Technician

There are two kinds of technicians in your dialysis center—patient care technicians (PCTs) and biomedical technicians. Both work under the guidance of the nephrology nurse or nephrologist.

Patient care technicians (PCTs) perform your dialysis treatment. In many dialysis centers, they are responsible for starting and ending each treatment and for monitoring you before, during and after treatments. PCTs complete an in-depth training program. Some states require that they have state or national certification.

Biomedical technicians are responsible for maintaining dialysis machines and water quality in your center. They order dialysis supplies and reprocess dialyzers (artificial kidneys) for reuse.

Vascular Access Care Team

If you are a hemodialysis patient, another group of health professionals will be involved in your care.

The vascular access surgeon will do minor surgery on your arm, leg, neck or upper chest to create an access that enables you to be connected to the artificial kidney, or dialyzer, for your treatments. Your access will be a fistula, graft or catheter. The surgeon will speak to you about the different access choices and help you select the best option for your needs. If any problems occur with your access at a later date, the vascular surgeon may need to repair the access surgically.

The radiologist will do special x-ray tests to help plan your access surgery. The radiologist may also place a catheter, repair a fistula that is not working properly and remove blood clots from an access. In some centers, a kidney doctor who has special training in radiology may do these procedures.

The access coordinator, who may be a nurse or other health professional, will review the history of your access, plan treatment, follow up to make sure you get the appropriate treatment and enter the information in your record.

Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body’s needs.

When is dialysis needed?

You need dialysis when you develop end stage kidney failure –usually by the time you lose about 85 to 90 percent of your kidney function and have a GFR of <15.

What does dialysis do?

When your kidneys fail, dialysis keeps your body in balance by:

• removing waste, salt and extra water to prevent them from building up in the body
• keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
• helping to control blood pressure

Is kidney failure permanent?

Usually, but not always. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

Where is dialysis done?

Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.

Are there different types of dialysis?

Yes, there are two types of dialysis –hemodialysis and peritoneal dialysis.

What is hemodialysis?

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.

However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft.

Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.

How long do hemodialysis treatments last?

The time needed for your dialysis depends on:

• how well your kidneys work
• how much fluid weight you gain between treatments
• how much waste you have in your body
• how big you are
• the type of artificial kidney used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

A type of hemodialysis called high-flux dialysis may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.

What is peritoneal dialysis and how does it work?

In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are two major kinds of peritoneal dialysis.

What are the different kinds of peritoneal dialysis and how do they work?

There are several kinds of peritoneal dialysis but two major ones are:
Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Automated Peritoneal Dialysis (APD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

Will dialysis help cure the kidney disease?

No. Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.

Is dialysis uncomfortable?

You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.

How long has dialysis been available?

Hemodialysis and peritoneal dialysis have been done since the mid 1940’s. Dialysis, as a regular treatment, was begun in 1960 and is now a standard treatment all around the world. CAPD began in 1976. Thousands of patients have been helped by these treatments.

How long can you live on dialysis?

If your kidneys have failed, you will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.  Life expectancy on dialysis can vary depending on your other medical conditions and how well you follow your treatment plan. Average life expectancy on dialysis is 5-10 years, however, many patients have lived well on dialysis for 20 or even 30 years. Talk to your healthcare team about how to take care of yourself and stay healthy on dialysis.

Is dialysis expensive?

Yes. Dialysis costs a lot of money. However, the federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state Medicaid programs also help with the costs.

Do dialysis patients feel normal?

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.

Do dialysis patients have to control their diets?

Yes. You may be on a special diet. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.

Can dialysis patients travel?

Yes. Dialysis centers are located in every part of the Pakistan and in many foreign countries. The treatment is standardized. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.